When do health insurance benefits reset?

Extras benefits reset in January or July depending on which fund you're with.

We’re reader-supported and may be paid when you visit links to partner sites. We don’t compare all products in the market, but we’re working on it!

When you take out health insurance, you may have noticed your extras treatments have an annual limit. For example, $300 for dental.

The good news is these reset each year, so you get a brand new limit to spend. Here's the list of each health fund in Australia so you can make the most of your benefits.

When do your benefits reset?

FundWhen Extras ResetFind out more
AHM logoahm health insurance1 JulyGo to Site
CUA_logoCUA Health1 JanuaryMore info
HCF logoHCF1 JanuaryGet quote
Medibank logoMedibank Private1 JanuaryGet quote
NIB logo
NIB
1 JanuaryMore info
Qantas Insurance logoQantas Health Insurance1 JanuaryGet quote
Suncorp1 JanuaryMore info
ACA Health Benefits Fund logoACA1 JanuaryMore info
Apia LogoAPIA1 JanuaryMore info
Australian Unity LogoAustralian Unity1 JanuaryMore info
Bupa logoBupa1 JanuaryMore info
CBHS Corporate Health logoCBHS Corporate1 January
CBHS health insurance logoCBHS Health Fund1 JanuaryMore info
CDH logoCDH Benefits FundNot statedMore info
Defence_Health_Logo_100Defence Health1 JulyMore info
Doctors Health Fund logoDoctors' Health Fund1 JanuaryMore info
Emergency Services Health logoEmergency Services Health1 JanuaryMore info
Frank health insurance logoFrank1 JanuaryMore info
GMHBA health fund logoGMHBA1 JanuaryMore info
GU Health logoGrand United Corporate HealthPolicies reset every 12 months from the effective date that you become a member.More info
HBF logoHBF1 JanuaryMore info
Health Care Insurance logoHealth Care Insurance1 JanuaryMore info
HIF health insurance logo

HIF

1 JanuaryMore info
Health Partners logoHealth Partners1 JanuaryMore info
Latrobe logoLatrobe Health ServicesNot statedMore info
Mildura LogoMildura Health Fund1 JanuaryMore info
MyOwn logoMyOwn Health1 JanuaryMore info
Onemedifund logo

onemedifund

1 JulyMore info
Navy Health Logo

Navy Health

1 JulyMore info
Nurses-and-midwives logoNurses & Midwives Health1 JanuaryMore info
Peoplecare logoPeoplecare Health Insurance1 JulyMore info
Phoenix health fund logoPhoenix Health Fund1 JanuaryMore info
Police health logoPolice Health1 JanuaryMore info
Queensland Country Health Fund logoQueensland Country Health FundMembership year based on when you joinedMore info
RT health fund logoRT Health Fund1 JanuaryMore info
Rbhs logoRBHS1 JanuaryMore info
St.lukes health logoSt.Lukes Health1 JanuaryMore info
Teachers health logoTeachers Health1 JanuaryMore info
Transport health logoTransport Health1 JanuaryMore info
TUH LogoTUH1 JanuaryMore info
UniHealth logoUniHealth1 JanuaryMore info
Westfund health insurance logo

Westfund

1 JanuaryMore info

Do these limits increase?

This depends on your health fund. With some extras cover policies, the annual limits remain the same each year.

However, with other policies, you may be rewarded for your loyalty with a benefit increase each year you remain a member. For example, your annual general dental cover limit in your first year of membership may be $500, but it may rise to $750 in your second year of membership and then continue to increase each year until you've reached a set maximum.

These increases typically only apply to some of the more major extras services, such as dental and optical.

Do these limits only apply to extras?

Yes. Hospital cover does not feature a set monetary limit on the benefit amount you are eligible to claim, so annual benefit limits only apply to extras cover. You can find out more about how hospital-only cover works in our handy guide.

What other limits can apply?

There are a few other extras cover limits you should be aware of. The first is a time limit, if you want to receive a rebate from your health fund for a health care service you've received, you must lodge your claim within two years of the service date.

The second limit you should be aware of is a service limit, as there may be a limit on the maximum number of times you can claim a benefit for the same service, for example an initial consultation with a physio, in a calendar year.

Finally, many health funds will also limit you to claiming one benefit per fund, per day. So if you receive multiple services within one consultation, you may only be able to claim the service which attracts the higher benefit.

What are the types of services that have annual limits?

Annual limits usually apply to a wide range of general treatments included in extras cover, such as:

However, there are certain parts of extras cover to which annual limits don’t usually apply, for example ambulance cover.

What is the difference between a combined limit and a sublimit?

When comparing extras cover, it’s important to be aware that sub-limits and combined annual limits may also apply. While your policy may have an annual limit of $1,000 for general dental services, there may also be a sub-limit that sets the maximum amount you can claim for a specific dental treatment, for example a routine checkup or a basic extraction. This sub-limit is subtracted from the larger annual limit.

However, combined annual limits may also apply. For example, your policy may provide up to $300 cover for each of the following services: physiotherapy, chiropractic treatment and osteopathy. However, those services may also be grouped together into one category with a combined annual benefit limit of $750 – so the maximum yearly amount you can claim for all the physio, chiro and osteo services you receive is $750.

How is annual defined?

The definition of annual depends on the calendar your fund uses:

  • Some funds use the calendar year: 1 January to 31 December
  • Some funds use the financial year: 1 July to 30 June

Your benefit tally resets at the end of each year, so check with your health fund to make sure you’re aware of what they deem to be the start of a new year.

Compare policies from 30+ Australian health funds

More guides on Finder

You might like these...

Ask an Expert

You are about to post a question on finder.com.au:

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • finder.com.au is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Finder only provides general advice and factual information, so consider your own circumstances, or seek advice before you decide to act on our content. By submitting a question, you're accepting our Terms of Use, Disclaimer & Privacy Policy and Privacy & Cookies Policy.
Go to site